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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213003960
Report Date: 09/03/2019
Date Signed: 09/03/2019 04:00:01 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CITY OF SAN RAFAEL - PARKSIDE CHILDREN'S CENTERFACILITY NUMBER:
213003960
ADMINISTRATOR:MCGRATH, KELLYFACILITY TYPE:
850
ADDRESS:51 ALBERT PARK LANETELEPHONE:
(415) 485-3387
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY:90CENSUS: 0DATE:
09/03/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Administator, Kelly AlbrechtTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA), Luis J. Gomez met with Administrator, Kelly Albrecht for this plan of correction inspection established on August 7, 2019. Upon arrival, LPA observed no school age children present during today’s inspection. The following deficiency from the previously inspection was checked today:

1596.7995 Employee or Volunteer at Day Care Center; This requirement is not met as evidenced by; LPA Gomez observed the proof of immunization's was missing from 3 personnel files.

Deficiency issued on August 7, 2019 have been cleared. 'Cleared POC Letter' was given to Administrator.

**No deficiencies were cited against the facility today under CCR,Title 22, Div. 12, Chapt. 1

>This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit was observed being posted.
Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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